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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Biliary metal stents should be placed near the hilar duct in distal malignant biliary stricture patients
Mitsuru Sugimoto, Tadayuki Takagi, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Yoshinori Okubo, Jun Nakamura, Mika Takasumi, Minami Hashimoto, Tsunetaka Kato, Ryoichiro Kobashi, Takumi Yanagita, Takuto Hikichi, Hiromasa Ohira
Mitsuru Sugimoto, Tadayuki Takagi, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Yoshinori Okubo, Jun Nakamura, Mika Takasumi, Minami Hashimoto, Tsunetaka Kato, Ryoichiro Kobashi, Takumi Yanagita, Hiromasa Ohira, Department of Gastroenterology, Fukushima Medical University, Fukushima 9601295, Japan
Yoshinori Okubo, Jun Nakamura, Minami Hashimoto, Tsunetaka Kato, Ryoichiro Kobashi, Takuto Hikichi, Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 9601295, Japan
Author contributions: Sugimoto M wrote the paper and designed and performed the study; Takagi T and Ohira H designed and oversaw the study; Suzuki R, Konno N, HA, Hikichi T, Nakamura J, Takasumi M, Sato Y, Irie H, Okubo Y, Hashimoto M, Kato T, Kobashi R, and Yanagita T provided clinical advice; and all the authors read and approved the final version of the manuscript.
Institutional review board statement: This study was approved by the Institutional Review Board of Fukushima Medical University, No. 2453.
Informed consent statement: The patients were not required to give informed consent because this study used anonymous clinical data obtained after each patient had agreed to medical activities by written consent. For full disclosure, the details of this study are published on the home page of Fukushima Medical University.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: The datasets analyzed during the current study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Mitsuru Sugimoto, MD, PhD, Assistant Professor, Department of Gastroenterology, Fukushima Medical University, 1 Hikarigaoka, Fukushima 9601295, Japan.
kitachuuou335@yahoo.co.jp
Received: September 17, 2021
Peer-review started: September 17, 2021
First decision: November 16, 2021
Revised: December 4, 2021
Accepted: March 25, 2022
Article in press: March 25, 2022
Published online: May 7, 2022
Processing time: 223 Days and 23.4 Hours
BACKGROUND
Endoscopic biliary drainage using a self-expandable metallic stent (SEMS) has been widely performed to treat distal malignant biliary obstruction (DMBO). However, the optimal position of the stent remains unclear.
AIM
To determine the ideal position for SEMS placement.
METHODS
In total, 135 DMBO patients underwent SEMS (uncovered or covered) placement over a ten-year period. A total of 127 patients with biliary obstruction between the junction of the cystic duct and Vater’s papilla were enrolled. An SEMS was placed through the upper common bile duct 2 cm from the biliary hilar duct in 83 patients (Hilar group) or near the top of the biliary obstruction in 44 patients (Lower group). Technical and functional success, adverse events, and risk factors for SEMS dysfunction were evaluated.
RESULTS
The stent patency period was significantly longer in the Hilar group than in the Lower group (P value < 0.01). In multivariate analysis, the only statistically significant risk factor for SEMS dysfunction was being in the Lower group (hazard ratio: 9.94, 95% confidence interval: 2.25–44.0, P < 0.01).
CONCLUSION
A longer patency period was achieved by positioning the SEMS near the biliary hilar duct.
Core Tip: Endoscopic biliary drainage using a self-expandable metallic stent (SEMS) has been widely performed to treat distal malignant biliary obstruction (DMBO). However, the optimal position of the SEMS remains unclear. This study indicated that the stent patency period was significantly longer when the SEMS was placed near the biliary hilar duct. Furthermore, the placement of a longer SEMS from the biliary hilar duct was thought to overcome several factors of recurrent biliary obstruction in DMBO patients.
